| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,964 |
4,781 |
$4.23M |
| D7140 |
Extraction, erupted tooth or exposed root |
3,572 |
2,783 |
$1.65M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,749 |
1,310 |
$676K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,201 |
815 |
$386K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
577 |
376 |
$145K |
| D9222 |
|
6,887 |
5,556 |
$91K |
| D2931 |
|
118 |
101 |
$83K |
| D2335 |
|
556 |
520 |
$66K |
| D1510 |
|
187 |
102 |
$64K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
37 |
37 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
224 |
130 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,878 |
5,542 |
$7K |
| 99070 |
|
24 |
24 |
$4K |
| 70310 |
|
24 |
24 |
$2K |